Divided Michigan Senate votes to expand nurses' role

LANSING — Michigan nurse practitioners and other nurses with advanced training could practice without oversight by physicians and prescribe drugs under legislation that won narrow approval Wednesday from the state Senate despite opposition from the doctors' lobby.

The bill, passed 20-18 and sent to the House for its consideration, would give more autonomy to and provide for the licensing of "advanced practice" registered nurses — nurse practitioners, nurse midwives and clinical nurse specialists.

Nurse practitioners have been playing a bigger role in the country's health care, particularly in areas with few physicians.

Supporters say giving the practitioners more leash like 18 other states do would keep them in Michigan and help address impending doctor shortages as baby boomers retire and more residents qualify for insurance under the federal health law.

"Why aren't we saying to the folks who can kind of do some of these core services that it's OK for them to be involved in some of this? They've been trained for it," said Sen. Mark Jansen, the bill sponsor and a Republican from Kent County's Gaines Township.

It makes sense to see doctors for severe problems and complicated procedures, he said, but patients should have the option to visit advanced nurses for routine checkups and sore throats.

But the medical establishment, fighting to protect its turf, said the move could endanger patients.

"Yes, advanced practice nurses are a step up — maybe several steps up. But they practice today collaboratively and with a supervisor. This is not a bad thing," said Sen. Roger Kahn, a Saginaw Township Republican and practicing cardiologist.

Nurses assess symptoms, he said, but only doctors should make a diagnosis after years of training.

Seventeen Republicans and three Democrats voted for the bill, while nine Republicans and nine Democrats voted against it.

Under changes made to the legislation, advanced nurses looking to practice and prescribe medicine would need four years of supervision under a physician or another APRN. Another amendment narrowly adopted, and which worries Jansen, would hold APRNs not under the supervision of a physician to the higher standard of care for doctors in medical malpractice lawsuits.

Doctors and advanced nurses have competing studies on who better controls costs by not overprescribing drugs and not ordering unnecessary tests.

Many advanced nurses work in doctors' offices and that mostly would not change if the bill becomes law, Jansen said, noting it includes a provision designed to prevent them from starting their own independent offices.

The legislation's future in the House is unclear.

"Lawmakers in the state House should do what the Senate wouldn't — reject this dangerous special interest legislation and instead put patients first," said Kenneth Elmassian, president of the Michigan State Medical Society.